Prosthetics Day 3

Question 1

Medicare functional classification levels: K0

Answer 1

no ambulatory potential with or w/o prosthesis- no reason for a prosthesis

Question 2

Medicare functional classification levels: K1

Answer 2

Low level: prosthesis would allow limited ambulation in household on level surface w/ little cadence change

Question 3

Medicare functional classification levels: K2

Answer 3

low level/ limited community ambulator, can perform steps and curbs, some cadence change

Question 4

Medicare functional classification levels: K3

Answer 4

independent community ambulator w/ varying cadence and activity levels; needed for full participation in vocational or leisure activities

Question 5

Medicare functional classification levels: K4

Answer 5

High level full independence in vocational or sports/leisure activity

Question 6

AMPnoPro tests with or without prosthetic?

Answer 6

w/o prosthetic

Question 7

What does the AMPpro test?

Answer 7

WITH prosthetic

Question 8

how many points do you need on the AMPpro test to qualify for a microprocessor

Answer 8

37/47

Question 9

pre-prosthetic interventions for girth and shape?

Answer 9

De-sensitization, elevation (dec swelling), scar tissue massage = wrapping is necessary for first 3-4 week

Question 10

when do you wear a shrinker (elastic sock)?

Answer 10

Always except for showering and when stiches are removed for up to a year post surgery to control swelling, help in shaping and promote healing.

Question 11

for a transfemoral amputation, to increase ROM what two hip muscles would you want to stretch to prevent hip contractures?

Answer 11

Hip flexors- prone press ups (contraction from wheelchair)
hip abductors exercises- since amputation can drift outward and get contracted

Question 12

for a transtibial amputation (below the knee), what muscle groups would you want to stretch?

Answer 12

hip flexors, hip abductors, + hamstrings (can do this by putting board under leg in wheelchair- we want them to extend to prevent knee contractures)

Question 13

what sitting position of the hip is common in amputee pts? How can we address this sitting position?

Answer 13

FLX, ABD, ER of the hip
can use a strap around knee to stretch hamstrings and keep leg flat against board

Question 14

what muscle groups would you work on strengthening if you had a TT for pre prosthetic ROM?

Answer 14

hip abductors, hip extensors, quads

Question 15

what muscle groups would you work on strengthening if you had a TF (above the knee) for pre prosthetic ROM? for walking

Answer 15

Hip ABD, hip ext (determines gait speed)

Question 16

what muscle groups would you work on strengthening if you had an UE amputation for pre-prosthetic interventions?

Answer 16

triceps and lower traps (closed chain)

Keep UE strength a priority.

Prevent impingement and overuse injuries ie. carpal tunnel, intact limb overuse, LBP

Question 17

How would managing overuse secondary to the assistive device look like in the thorax for pre-prosthetic interventions?

Answer 17

trunk management- flexion position all the time- do trunk extension and work on core because people collapse

Question 18

How would managing overuse secondary to the assistive device look like in the INTACT limb in pre-prosthetic interventions?

Answer 18

manage impact and overuse- invest in good sneakers/shoes

Question 19

What are some types of pre- prosthetic interventions categories?

Answer 19

1. balance
2. transfers
3. ADL’s
4. Locomotion without prosthesis (ambulation w/ AD), fall risk?
5. WC mobility- can they manage own wheelchair?

Question 20

Phantom sensation vs phantom pain?

Answer 20

Phantom sensation- hurts a lot with limb still there
- you can do de-sensitization things like: TENS, tapping, massage, acupuncture, shrinker, prosthetic usage

Phantom pain- hurts with no limb present

Question 21

what is the targeted muscle re-innervation?

Answer 21

Surgical procedure for the prevention or treatment of neuroma to help phantom limb pain. Nerves in the LE amputation can be transferred to more proximal motor points or buried to prevent neuromas from developing

Question 22

What is myodesis?

Answer 22

a surgical procedure where the muscles are attached directly to the bone in an amputation surgery. Provides better stabilization for ischemic limbs

Question 23

what is myoplasty

Answer 23

Involves suturing muscles together, typically opposing muscle pairs like flexors and extensors.The goal is to create a soft tissue covering over the amputation stump.Myoplasty should be avoided in the digits because it can compromise motion.

muscle is attached to muscle then placed over the end of the bone for distal muscle stabilization

helps to stabilize them and helps stabilize socket

Question 24

BONE BRIDGE – Ertl Procedure

Answer 24

Bone bridge amputation surgery, also known as the Ertl procedure, isa surgical technique that involves creating a bone bridge between the tibia and fibula during a transtibial amputation so they can weight bear

Question 25

INTERVENTIONS WITH A PROSTHESIS

Answer 25

1. Wearing Time (why???) Set up a schedule!! 2. Don & Doff with Skin Inspection- how to put it on and off properly- bad vs good pressure areas, how to know if its on properly, sock management 3. Educate the amputee about their prosthesis: components and how to take care of them so no infections 4. Balance & Coordination 5. Gait Training 6. Functional Activities – Floor Transfers, bathroom transfers

Question 26

What are some components that include donning a prosthesis? making sure it fits

Answer 26

1. Fabric liners- do not need alcohol 2. They shrink throughout the day- pressure= fluid moves= More socks to lift up to the spot where they are supposed to be 3. Initial phase- still changing- socks 4. Want gel liner to adhere to skin - other parts sweat excessively after amputation- because they lost a part of their body that sweats- hidrosis- liner fabric depend - Condyles are used for suspensions- socks keep a tight fit

Question 27

steps in donning

Answer 27

1. Put on liner inside out- when you roll it is right side (No bubbles- important- biggest thing they do that is wrong). If there is air- sucks on bottom of limb- blisters 2. Rings of liner are unfolded and around 3. Seal in liner- tightly, of rings- rings needs to be tight- the rings seal- you have to push it tightly, but it can’t go all the way to the bottom 4. Rubbing alc mixture- squirt inside prosthetic 5. Push in

Question 28

examples of balance and coordination exercises

Answer 28

1. sit to stand 2. diagonal, AP, ML wt shifting 3. swing and stance motions 4. step ups and step overs w/ sound limb 5. single leg stance 6. standing- reactive and anticipatory

Question 29

Functional Activities

Answer 29

transfers – all types, all surfaces ramps/inclines stair climbing kneeling ADLs, IADLs (lift and carry) work skills/tasks running/sports/recreation

Question 30

pt ed examples- pertaining to prosthetic management

Answer 30

- sock management: wear/keep socks clean Jammed into bottom, hear pistoling (air)- need another sock, proper number of socks proper fit/ # ply / donning & doffing - hygiene: skin, socket, cover, liners, sleeves skin care: check skin frequently (mirror), prevent problems (sweat), do you know you have a callous here? Do not feel it in good foot. - wearing time: increase gradually wrap/shrinker when not wearing prosthesis - positioning: prone- good for back, prevents hips flexion contractures- but no one likes it= have them do it, stretching, HEP - component care: charging, battery life, default modes, waterproof, warranty - any problems – discomfort, skin, noises, etc. – see prosthetist, PT, or MD

Question 31

unilateral transtibial oxygen use

Answer 31

slight increase O2 than normal

Question 32

unilateral transfemoral- O2

Answer 32

50% more O2 than normal

Question 33

dysvascular prosthetic user

Answer 33

Use more O2 than traumatic counterparts

Question 34

Assessment of Prosthetic Fit and Function: Sitting

Answer 34

1. Identify/evaluate each of the types of prosthetic componentry and suspension- this was fitted last week, how did thy show you how to put it on? 2. How many ply socks does the patient have on? 3. Can the patient don the prosthesis easily/independently? 4. Is the person comfortable in sitting?

Question 35

Assessment of Prosthetic Fit and Function: Standing

Answer 35

1. Check the foot position too inset or too outset? 2. Is the foot flat on the floor? It should be flat on the floor- not too far in front or behind Is there excessive lean of the pylon forward or to the side? 3. Is there overall balance and symmetry between the two legs? ' 4. Height is lower- develop back pain and bed happens- you should not make prosthetics shorter for it to be easier to clear- good therapy, you will be okay w/o making it shorter

Question 36

Assessment of Prosthetic Fit and Function/ Standing

Answer 36

Is the person comfortable in standing with an approximate 6” BOS? 6. Does the leg length seem equal? 7. Is the prosthetic knee stable in standing?

Question 37

Assessment of Prosthetic Fit and Function Standing

Answer 37

8. Is the ischium contained within the socket? If there is something wrong, they could have lateral trunk lean, this is important to be even 9. Is there any flesh roll above the socket on any side? Abductor area- common- bc of poor wrapping or poor shrinking 10. Is there any vertical pressure in the perineum? 11. Is the amputee's limb able to get fully into the socket? Gain weight more than 10 lbs or loose 10 lbs after fitted for prosthesis- will not fit in socket

Question 38

Assessment of Prosthetic Fit and FunctionWalking

Answer 38

Is there any pistoning- Noises (air escape during sit to stand) when lifting and lowering the prosthetic limb? Are they moving up and down and side to side? Is there any pinching or gapping of the socket? Does the suspension function effectively? Is it keeping on them properly or falling off

Question 39

prosthetic gait examination components

Answer 39

1. use of assistive device- least amount for safety 2. transfers- on varied surfaces, varied heights, varied directions 3. Gait deviations- observe from all directions, prosthetic vs anatomic 4. stairs, curbs, ramps- ascend and descend

Question 40

what outcome measure test can be used to assess mobility?

Answer 40

TUG four step square test figure 8 walking 5x Sit to stand

Question 41

what outcome measure test can be used to assess gait?

Answer 41

Gait speed- 2 minute walk test or 6 minute walk test

Question 42

5 Ways to preserve the remaining foot

Answer 42

1. pt and family education about foot care 2. Wound care 3. protective footwear 4. shoe modifications 5. unloading devices (AD)

Question 43

ulcer prevention

Answer 43

1. no slippers- proper footwear 2. custom shoes molded orthotics 3. daily inspection 4. assistive devices to decrease WB 5. Minimize gait deviations

Question 44

steps in assessing the foot

Answer 44

1. skin inspection 2. check pulse 3. check sensation 4. thorough medical history 5. foot deformity 6. stage the wound

Question 45

4 levels of wound staging

Answer 45

1. redness of skin, but not broken or open sore yet 2. partial thickness tear... blister 3. full thickness tear but now through subcutaneous tissue 4. Deeper structures (into muscle, ligs, tendon)

Question 46

purposes of shoe modifications

Answer 46

1. distribute weight bearing forces over a large area 2. reduce stress on remaining foot 3. promote healing through pressure relief 4. allow safer mobility and function

Question 47

what is a transmetatarsal amp technique

Answer 47

a surgical procedure that removes the forefoot at the level of the metatarsal shafts. Foot cut in the middle of the metatarsals. salvages rest of limb, Preserves a weight-bearing platform, allowing for early ambulation and maintaining independence

Question 48

Lisfranc Amputation

Answer 48

amputation after 2 carpal rows (cuneiform and cuboid bones) of bones and before metatarsals can be a good option because it preserves limb length, which allows for a higher level of ambulation. However, it can result in a short amputation stump that can cause muscle imbalance and foot drop

Question 49

Chopart amputation

Answer 49

removes the forefoot and midfoot, saving talus and calcaneus controversial procedure that's considered unstable because most of the tendons around the ankle joint are no longer attached to the foot

Question 50

Syme Amputation

Answer 50

Disarticulates the talocrural joint and trims malleoli for a flat weight bearing surface removes the foot through the ankle joint while preserving the heel pad

Question 51

what is charco foot/ diabetic neuropathic osteoarthropathy?

Answer 51

ds that attacks the bones, joints, and soft tissue in your feet. Can cause painful sores and change shape of your feet. Affects people who cannot feel anything bc of nerve damage. Leads to severe joint deformities.

Question 52

what is a removeable cast walker

Answer 52

a knee-high offloading device that allows patients to walk while reducing pressure on a wound. RCWs are used to treat diabetes-related foot ulcers (DRFUs) and can also help improve balance (a boot) not cast- what they would give for gymnastics

Question 52

off loading strategies

Answer 52

1. total contact cast- regular cast with brace holding it on outside to allow walking 2. posterior walking splint - splint b=made just for back of calf 3. removeable cast walkers- a boot (what they gave for gymnastics) 4. calf corset- lace up orthosis with custom rocker shoe on the bottom 5. Arizona orthosis (lace up boot like a brace)

Question 52

posterior walking splint

Answer 52

A posterior walking splint extends from the metatarsal heads or great toe's plantar surface, down the lower leg's posterior side. It ends about two inches below the fibular head to avoid putting pressure on the common peroneal nerve. Splints can provide similar pressure relief to a cast, but they're easier to remove and can be adjusted to accommodate swelling. They're also less likely to cause complications than casts

Question 53

total contact cast

Answer 53

a non-removable cast that's used to treat foot conditions and redistribute pressure on the foot

Question 54

guidelines for preventative footcare:

Answer 54

1. wash and dry feet + b/w toes 2. moisturize feet, not toes 3. trim toenails after washing and drying feet 4. have podiatrist address any ingrown toenails 5. manage corns/callouses 6. check water temp for bath 7. use sunscreen on top of feet during summer 8. wear socks at night if feet are cold 9. ask healthcare provider to check feet at each level

Question 55

self foot inspection

Answer 55

1. inspect al surfaces of the feet daily (including b/w the toes) for signs of injury 2. report any injuries to a health care provider immediately 3. feel for increased areas of temperature 4. check for tender areas on bottom of feet 5. use a mirror if necessary to see bottom of feet 6. have someone check feet for you

Question 56

footwear care

Answer 56

1. wear shoes that fit the shape and size of feet and leave room for any insoles 2. ask healthcare provider to recommend correct type of shoe 3. break in new shoes slowly 4. keep shoes and insoles in good repair 5. always wear socks or stockings with shoes, wearing a clean pair daily 6. before putting dshoes on, check for rough areas, torn linings, or loose objects that can injure the foot

Question 57

prosthetic management education components

Answer 57

1. correct donning and doffing wearing schedule 2. sock management/skin inspection/shrinker 3. how do they components works? 4. care of the prosthetics: cleaning, charging, maintenance

Question 58

LLD stands for and can cause what body asymmetries

Answer 58

Leg Length Discrepancy- Limping or toe-walking  Back, hip, knee, or ankle pain  A tilted shoulder  A chronically hyperextended knee on the short side and flexed on the long side

Question 59

if the prosthesis is too short there will be decrease _________ __________ ____________________

Answer 59

transverse pelvic rotation

Question 60

if the prosthesis is too short there will be decrease _____ __________ which causes ____________________

Answer 60

knee flexion; vaulting

Question 61

gait training- muscles that assist in weight acceptance

Answer 61

Hip extensors, dorsiflexor's, quadriceps

Question 62

gait training- muscles that assist in single limb support

Answer 62

Abdominals, back extensors, hip abductor, plantar flexors

Question 63

gait training- muscles that assist in swing phase

Answer 63

hip flexors, adductors, back extensors

Question 64

ambulation problems

Answer 64

sound limb is biased to midline, decreased toe load, decreased prosthetic knee flexion, decreased pelvic rotation

Question 65

long term higher loading, repetitive forces on one single limb can lead to premature

Answer 65

1. osteoarthritis 2. excess pain 3. overuse injuries/breakdown

Question 66

what are the 6 determinants of gait?

Answer 66

1. step width 2. step length 3. toe load 4. knee flexion 5. pelvic rotation 6. trunk rotation

Question 67

difference between heel strikes of 2 CONSECUTIVE foot contacts is which component of gait determinants?

Answer 67

step width

Question 68

step width can be affected by Adducted ______ limb and abducted _______ limb

Answer 68

adducted sound limb, abducted prosthetic limb and this can be due to habit, weakness or poor balance

Question 69

difference between 2 DIFFERENT feet is which component of gait determinants?

Answer 69

step length

Question 70

what is a step length deviation and its probable cause?

Answer 70

prosthetic to sound limb can have shorter step lengths due to fear, inability to balance over the prosthesis, pain or discomfort

Question 71

what is toe load/toe off and what are normative values of toe ext?

Answer 71

normative values of toe ext- 20-55 degrees Toe-off, or pre-swing, is the final phase of stance in the gait cycle and occurs when the toe is lifted off the ground. It's the moment when the body weight shifts from the rear leg to the front leg, and the swing phase begins

Question 72

A toe load deviation would include a lack of toe break or toe off to propel you forward which can be due to what 4 things?

Answer 72

1. lack of pelvic floor rotation 2. poor balance 3. lack of hip extension 4. contracture of flexors

Question 73

how much knee flexion should you have during pre swing?

Answer 73

30-40 degrees

Question 74

how much knee flexion should you have during initial swing?

Answer 74

should have more flexion of knee at initial swing because you need to start swinging and clear the ground- 60 degrees

Question 75

Deviation would be lack of knee flexion due to what 3 probable causes?

Answer 75

1. decreased pelvic rotation 2. unable to roll over the toe 3. prosthesis is too short

Question 76

pelvic rotation normative values

Answer 76

5 degrees forward both sides

Question 77

what is the pelvic rotation gait deviation?

Answer 77

prosthetic side rotates posteriorly

Question 78

what are 2 causes for the pelvic rotation?

Answer 78

1. lack of pelvic transverse rotation 2. limb length deficiency- short

Question 79

trunk rotation normative value

Answer 79

5 degrees in opposition to the pelvis

Question 80

what from the upper body will cause a trunk rotation deviation?

Answer 80

Asymmetrical arm swing

Question 81

what are some probable causes for a trunk rotation deviation?

Answer 81

1. inability to balance over the prosthesis 2. habit 3. assistive device

Question 82

4 benefits of symmetrical arm swing

Answer 82

1. improved balance 2. energy efficiency- conserves energy 3. improved forward momentum 4. natural looking gait

Question 83

What is a common gait deviation relating to the trunk?

Answer 83

1. improving trunk rot decreases lat trunk lean 2. controlled SLS lessens lat trunk lean 3. timely gluteal activation lessens lean 4. hip ext, hip abd, core muscles- strengthen

Question 84

3 Hip extensor functions

Answer 84

1. predictor of gait speed 2. push over prosthetic foot- aids inpropulsion 3. Contract from initial contact to midstance for pelvic control

Question 85

Hip abductors functions

Answer 85

1. improves balance in stance (w/ hip extensors) 2. contract from midstance to terminal stance to control pelvic tilt

Question 86

______ _______ _______ is good predictor for ambulation and balance in amputee population

Answer 86

Single Limb Standing

Question 87

6 prosthetic gait training goals

Answer 87

1. minimize gait deviations 2. symmetry- equal step lengths, timing 3. safety 4. maximize prosthetic performance 5. improve function 6. energy efficiency

Question 88

PT interventions

Answer 88

1. postural re-ed 2. balance training- static and dynamic 3. weight shift/acceptance 4. restore trunk and pelvic rotation 5. strengthening/timely muscle activation

Question 89

What are the 3 types of phantom sensation?

Answer 89

1. movement - willed/controlled or spontaneous- missing limb is moving; toes curled 2. kinesthetic-feeling like it is in a certain position; size/shape/position- hand is twisted when it it not 3. exteroceptive- pressure, touch, tingling, temp, vibration, itching

Question 90

what are the classification levels of LE amputations?

Answer 90

1. transtibial 2. transfemoral 3. knee disartic, partial foot (symes?) 4. Hip disartic

Question 91

What is the purpose of classification levels such as K levels- K0, K1 etc?

Answer 91

medicare functional classification levels- validate need for PT ad used for insurance

Question 92

Which K level is regarded as functional for insurances approval?

Answer 92

K3

Question 93

what is the max score for an AMPnoPRO

Answer 93

43

Question 94

What is the max score for an AMPPRO?

Answer 94

47

Question 95

AMPnoPRO scores for K0-K4 (w/o prosthesis)

Answer 95

K0-K1= 9.67 K2= 25.28 K3= 31.36 K4= 38.49

Question 96

AMPPRO scores for K0-K4 (w/ prosthesis)

Answer 96

K0-K1= 25 K2= 34.65 K3= 40.50 K4= 44.67

Question 97

how long can swelling last after amputation?

Answer 97

1 year

Question 98

when your stiches are removed you can wear _______ to help with girth and shaping for pre-prosthetic interventions

Answer 98

shrinker (sock)